Thoughts on medicine in sports

September 23, 2009

Article raises dissenting opinion to sickle cell trait testing

A recent article in the San Francisco Chronicle questions the necessity of testing NCAA athletes for sickle cell trait and claims such a policy could also lead to discrimination against minority players.

A quote related to the first point:

...in several cases where athletes with the trait died, doctors found evidence of "sickling" in their blood cells. Vichinsky and other doctors say researchers don't know if the sickling was brought on by intense exercise and played a role in their deaths, or if the blood cells took on the sickle shape after death.

But there are studies that have shown that those with sickle cell trait "are markedby biological and clinical differences in comparison with subjectswith normal Hb". I would also add that the clinical presentation of those with presumed sickle associated collapse (exhaustion early in an intense workout) seems to be different than that of heat stroke (elevated core temperature, often dehydration, after exercise of a longer duration) indicating that they are distinct entities.

And the second point:

Some doctors and ethicists said it's easy to imagine some coaches easing up on athletes with sickle cell trait, especially since there has already been a lawsuit.

"The idea is coaches are supposed to work out an individual plan with that athlete, but unconsciously you can imagine they're going to be worried about their liability," said Marsha Treadwell, who works with patients at Children's Hospital's sickle cell center. "Those athletes are not going to get the same conditioning."

I'd argue that we probably have no choice. They absolutely shouldn't be pushed as hard because doing so puts this type of athlete at risk.

Now I am always sensitive to the notion, as is raised in the article, that we should have to prove a condition is risky or an intervention is effective before it is mandated. The sudden cardiac death screening debate is an excellent comparison. I haven't seen evidence to convince me that it is worthwhile to screen all athletes with an EKG or echocardiogram. Sickle cell trait and sudden death faces the same challenge when it comes to ressearch - deaths are rare so it takes huge numbers and lots of time in order to see if you've made a difference. As I've mentioned before, I think the decision to go ahead with sickle cell testing is easier than cardiac screening issues because A) the test is already done on everyone B) there is no gray area with the test, either you have the trait or you don't C) those indentified with the condition do not have to be restricted from play, just educated.

I do think it is reasonable to study whether or not such screening engenders any feelings of discrimination among athlete populations. If testing is offered to all ethnic groups - as it should since sickel cell trait affects other groups besides those of African descent - and all involved are educated adequately on the nature of the condition and how to prevent complications then I would think we can avoid any ethical quandries.